A low cost virtual reality system for home based rehabilitation of the arm following stroke: a randomised controlled feasibility trial

Abstract

Objective:To assess the feasibility of conducting a randomised controlled trial of a home-based virtual reality system for rehabilitation of the arm following stroke.Design:Two group feasibility randomised controlled trial of intervention versus usual care.Setting:Patients’ homes.Participants:Patients aged 18 or over, with residual arm dysfunction following stroke and no longer receiving any other intensive rehabilitation.Interventions:Eight weeks’ use of a low cost home-based virtual reality system employing infra-red capture to translate the position of the hand into game play or usual care.Main measures:The primary objective was to collect information on the feasibility of a trial, including recruitment, collection of outcome measures and staff support required. Patients were assessed at three time points using the Wolf Motor Function Test, Nine-Hole Peg Test, Motor Activity Log and Nottingham Extended Activities of Daily Living.Results:Over 15 months only 47 people were referred to the team. Twenty seven were randomised and 18 (67%) of those completed final outcome measures. Sample size calculation based on data from the Wolf Motor Function Test indicated a requirement for 38 per group. There was a significantly greater change from baseline in the intervention group on midpoint Wolf Grip strength and two subscales of the final Motor Activity Log. Training in the use of the equipment took a median of 230 minutes per patient.Conclusions:To achieve the required sample size, a definitive home-based trial would require additional strategies to boost recruitment rates and adequate resources for patient support.

Home-based physiotherapy programmes for individuals with neurological diseases: systematic review

“…All fifteen studies included were randomized controlled trials [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] and were randomized in a blinded manner. Following the appraisal of methodological quality PEDro and Cochrane Collaboration tool, all studies performed well in terms of internal validity (randomization) as well as the results and quality of reporting (e.g., incomplete outcomes, selective outcome reporting and other biases).…”

“…Others three studies used virtual reality rehabilitation programme to improve arm function [29,37] and balance [39]. One study utilized a step training mat, connected wirelessly to the television by a console, to improve balance, stepping, cognition and functional performance in people with Multiple Sclerosis [35].…”

Virtual reality in medicine: a brief overview and future research directions

“…Virtual rehabilitation involves both activities carried out 'here and now' and therapy conducted at a distance, called telerehabilitation. A number of reports have been published on this subject, including meta-analyses [14][15][16][17][18][19][20][21][22] evaluating the efficacy of different technical solutions. Standen et al [20] found that VR-based games might also be used at home to help improve motor function in upper limbs after a stroke.…”

“…A number of reports have been published on this subject, including meta-analyses [14][15][16][17][18][19][20][21][22] evaluating the efficacy of different technical solutions. Standen et al [20] found that VR-based games might also be used at home to help improve motor function in upper limbs after a stroke. Thanks to a variety of tasks, images, and effects that can make conventional motor treatment more engaging, rehabilitation with VR guarantees a greater involvement of the patient and makes them more motivated to exercise regularly.…”

Motivating Rehabilitation Through Competitive Gaming

“…Standen [ 39 ] showed a low-cost virtual reality system for home-based rehabilitation. Participants were assessed at baseline, 4 and 8 weeks using the WMFT and other tests of Daily Living [ 40 ].…”